Primary health care providers in rural settings can play a vital role in the identification, management, and referral of adolescents with problematic alcohol involvement. This application proposes a cooperative agreement to develop the research capacity of primary health care systems in rural northwestern Pennsylvania for addressing alcohol use and related problems in this age group. The Northwest Pennsylvania Adolescent Alcohol Research Cooperative (NPAARC) will include members from the Pittsburgh Adolescent Alcohol Research Center, the Center for Rural Health Practice at the University of Pittsburgh - Bradford campus and the Kinzua Regional Health Alliance. The Kinzua Alliance includes primary health care organizations serving rural northwestern Pennsylvania. These organizations provide complimentary expertise and resources for conducting the proposed research. NPAARC will assess the extent of underage drinking in the served communities through local high school participation in the Pennsylvania Youth Survey, as well as the evaluation of patients visiting primary care practices. To identify and involve all area practitioners serving this population, a survey and focus groups will be conducted. In collaboration with practitioners, adolescents and parents, an adolescent version of the NIAAA Clinician's Guide and a computer-assisted alcohol assessment and clinical decision support tool will be developed. The computer-assisted decision support system will be tested in five practices. Before their health care visit, adolescents (12-20 years old) will be assessed on alcohol use and problems, including the AUDIT and a computer-administered diagnostic assessment. To determine the influence of this decision support system, practitioner assessment and referral practices and adolescent adherence to recommendations will be compared during two implementation stages: (1) an assessment only control condition and (2) a full implementation including PCP feedback, interpretation of assessments, intervention suggestions, and a tailored print-out provided to the patient. The study will evaluate the influence of the computer-assisted decision support system on practitioner assessment and referral patterns, patient adherence to referral recommendations over a one-month follow-up period and adolescent alcohol consumption. With this project, NPAARC will initiate a long-term partnership among rural health care providers, the Center for Rural Health Care Practice, and the Pittsburgh Adolescent Alcohol Research Center. [unreadable] [unreadable] [unreadable]